ABSTRACT
Antifungals are a class of drugs that target the treatment of invasive fungal infections. This includes polyenes, triazoles, and echinocadins. Among these, azoles are being extensively used nowadays. Triazoles have become standard for the azoles and have replaced amphotericin B as the first line of defence for fungal infections. With the increased cases of fungal infection, which affect a majority of the population at different stages and situations, one such section of the population is pregnant females. The rate and susceptibility of fungal infections are particularly higher in pregnant females, as the immunity of the mother is highly compromised. Systemic fungal infections like invasive aspergillosis, esophageal candidiasis, and candidemia are being treated with new age triazole antifungals like voriconazole. Prolonged and high concentrations of this drug are associated with various developmental anomalies. With this aim, teratogenic studies were performed on pregnant female mice during gestation and the weaning/lactation period to observe the effects of voriconazole at different dosages (8â¯mg/kg b.w., 10â¯mg/kg b.w., and 20â¯mg/kg b.w.). Pregnant dams were subjected to 20â¯mg/kg b.w. Voriconazole had a small litter size and a high number of resorptions. Craniofacial defects in the form of reduced ossification and widely open sutures, the presence of the 14th rib, asymmetry in the sternebrae, and the absence of ossified distal phalanges were some of the skeletal anomalies which were significant in the foetus and pups subjected to both 10â¯mg/kg b.w. and 20â¯mg/kg b.w. doses of voriconazole.
ABSTRACT
BACKGROUND: Previous studies have shown that carotid intima-media thickness correlates well with the presence and extent of coronary artery disease. This study was conducted to determine whether it could reliably predict the presence of left main coronary artery disease. METHODS: Common carotid intima-media thickness was measured in 50 patients with angiographically proven significant (> or =50%stenosis) left main coronary artery disease and in another 50 age- and sex-matched patients with coronary artery disease without the involvement of the left main coronary artery. Measurements of the carotid intima-media thickness were made on the far wall 1 cm from the distal end of the common carotid artery bilaterally, and the average and the greater of the two values thus obtained for each patient were used for analysis. Plaques were not included in the measurement of carotid intima-media thickness. RESULTS: The average and greater of the two values were significantly higher in patients with left main coronary artery disease as compared to those without it (average intima-media thickness: 0.926 +/- 0.12 vs. 0.78 9 +/- 0.16 mm; p< 0.001; greater intima-media thickness: 0.994 +/- 0.13 vs. 0.844 +/- 0.20 mm; p< 0.001). The cut-off values of 0.81 mm for the average carotid intima-media thickness and 0.87 mm for the greater carotid intima-media thickness were found to have optimum sensitivity (92% and 90%, respectively) and specificity (60% and 64%, respectively) for the detection of left main coronary artery disease. A higher cut-off value of 1.0 mm increased specificity to 92% and 84%, respectively, for the average and greater thicknesses, but sensitivity decreased markedly. CONCLUSIONS: There is a significant association between increased carotid intima-media thickness and the presence of left main coronary artery disease. The measurement of carotid intima-media thickness can be used with reasonably good sensitivity and specificity for the detection of left main coronary artery disease in patients who are undergoing evaluation for suspectedcoronary artery disease.
Subject(s)
Carotid Arteries/pathology , Carotid Stenosis/pathology , Coronary Artery Disease/pathology , Tunica Media/pathology , Adult , Analysis of Variance , Carotid Arteries/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Chi-Square Distribution , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Echocardiography , Female , Humans , Male , Middle Aged , Risk Factors , Tunica Media/diagnostic imagingABSTRACT
BACKGROUND: Carotid intima-media thickness and pulse wave velocity are non-invasive markers of atherosclerosis and have been shown to reliably predict presence and extent of atherosclerotic vascular disease. However, studies examining their association with each other have shown inconsistent results. Hence it was sought to assess correlation between carotid intima-media thickness and pulse wave velocity in patients with and without coronary artery disease. METHODS AND RESULTS: Sixty-four patients with angiographically proven coronary artery disease and 84 age-matched individuals without coronary artery disease but having one or more conventional cardiovascular risk factors were included in the study. Individuals with established cerebrovascular disease and peripheral vascular disease were excluded from the study. Carotid intima-media thickness of far wall was measured at three predefined sites (distal common carotid, carotid bifurcation and proximal internal carotid artery) on each side. Brachial-ankle pulse wave velocity was measured non-invasively using VP 1000 (Colin Corporation) automated ABI/ PWV analyzer. There was no significant difference in gender and presence of cardiovascular risk factors in the two groups. Mean and maximum carotid intima-media thickness and brachial-ankle pulse wave velocity were all significantly higher in coronary artery disease patients as compared to patients without coronary artery disease (0.842 v. ( 0.657 mm, p <0.0001; 1.076 v. 0.795 mm, p <0.0001; 1708.63 v. 1547.26 cm/s, p <0.0004 respectively). There was a significant correlation between brachial-ankle pulse wave velocity and both mean and maximum carotid intima-media thickness in patients with coronary artery disease (r = 0.47, p <0.0001 and r=0.41, p < 0.0008 respectively) but not in individuals without coronary artery disease (r=0.01 and -0.1 respectively). CONCLUSIONS: Presence of significant correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with coronary artery disease but absence of the same in individuals without major atherosclerotic vascular disease suggests that the correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity becomes stronger with increasing extent of atherosclerosis.
Subject(s)
Carotid Arteries/pathology , Carotid Stenosis/pathology , Coronary Artery Disease/pathology , Tunica Intima/pathology , Tunica Media/pathology , Adult , Ankle/blood supply , Arteriosclerosis/diagnostic imaging , Arteriosclerosis/pathology , Arteriosclerosis/physiopathology , Blood Flow Velocity , Brachial Artery/diagnostic imaging , Carotid Arteries/diagnostic imaging , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/physiopathology , Case-Control Studies , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/physiopathology , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Probability , Prognosis , Reference Values , Risk Assessment , Ultrasonography, Doppler , Vascular PatencyABSTRACT
Endothelial dysfunction is the final common pathway through which various coronary risk factors culminate into atherosclerosis and subsequent coronary artery disease (CAD). Endothelial function can be reliably assessed by flow mediated vasodilatation (FMD) in the brachial artery using high-resolution ultrasonography and has been shown to be an excellent surrogate marker for the presence of CAD. Two hundred and forty-one individuals comprising of 101 patients with CAD (angiographically proven, or with history of documented myocardial infarction) and 140 individuals without CAD were included in the study. All subjects underwent clinical evaluation, fasting lipid profile, treadmill test and FMD assessment. Selected individuals underwent coronary angiography too. Brachial artery diameter and Doppler indices (systolic and diastolic velocity time integrals) were recorded using high resolution ultrasonography at baseline, immediately after and at one minute after release of cuff (occlusion time 5 minutes). FMD was calculated as percentage increase in brachial artery diameter at one minute. FMD index was calculated as the ratio of FMD and percentage increase in flow during reactive hyperaemia. Mean FMD was significantly higher in non-CAD group (8.71+/-4.77%) than in CAD group (3.77+/-2.03%; p < 0.0001). The FMD index was also significantly higher in the non-CAD group (0.031 ) than in CAD group (0.021; p=0.0117). On multiple regression analysis, FMD index was found to be significantly associated with presence of CAD (p=0.0015), independent of conventional cardiovascular risk factors. Endothelial function as assessed by FMD is significantly depressed in patients with established CAD and this association is independent of presence of conventional cardiovascular risk factors.
Subject(s)
Brachial Artery/physiopathology , Coronary Artery Disease/physiopathology , Endothelium, Vascular/physiopathology , Vasodilation/physiology , Blood Flow Velocity , Brachial Artery/diagnostic imaging , Case-Control Studies , Female , Humans , Male , Middle Aged , UltrasonographyABSTRACT
OBJECTIVE: The aim of this study was to investigate expressed preferences for family physician (FP) gender among Canadian European-descent (CED) and Canadian South-Asian (CSA) immigrant women. METHOD: An 'on-site' survey was conducted in community-based institutions in Toronto in order to determine preferences for the gender of FP under various health care scenarios: overall health care; gender-sensitive examinations; emotional problems; general ailments; and life-threatening conditions. RESULTS: Ninety-four women responded to this survey (CED = 50, CSA = 44), response rate 77.3%. For all health care scenarios, CED and CSA women similarly expressed either a preference for a female FP or no preference. More than two-thirds of women preferred a female FP for gynaecological examinations (CED, 72.9%; CSA, 83.7%) or examinations with private body part exposure (CED, 72%; CSA, 81.8%). For 'emotional problems', half of the women preferred a female FP and the other half had no preference. A similar pattern was observed for 'overall health care', with some shift to female physician preference among CSA women (60.5%) compared with CED women (53.2%). For the 'overall health care' scenario, CED and CSA women who preferred a female FP had a higher frequency of seeing female physicians within the last 5 years (CED, P < or = 0.01; CSA, P < or = 0.05), and attributed 'positive' social skills more to female physicians (CED, P < or = 0.01; CSA, P < or = 0.01) compared with women with no preference for the gender of the FP. Yet, CED women with a female FP preference were more likely to have a concurrent female FP (P < or = 0.01), and to rate past experiences with female physicians as high (P < or = 0.01) and with male physicians as low (P < or = 0.05) compared with CED women with no preference. In the CSA group, women with a preference for a female FP were more likely to be unemployed (P < or = 0.01) and have low social support (P < or = 0.01). CONCLUSIONS: Despite similar physician gender preference patterns, factors associated with these preferences show some differences between CED and CSA women.