The prognostic implications of lack of palpitations in patients hospitalised with atrial fibrillation: observations from a 20-year registry.

OBJECTIVES: It is well recognised that patients differ in the clinical presentation of atrial fibrillation (AF), ranging from the typical symptom of palpitations, atypical symptoms in others and a substantial that are asymptomatic. Whether the different patterns of presentation are associated with differences in outcomes is not known. The aim of this study was to evaluate the prevalence and the prognostic implications of lack of palpitations among patients hospitalised with AF in a large prospective registry. METHODS: Retrospective analysis of all patients hospitalised with AF in Qatar from 1991 to 2010 was made. Patients were divided into two groups according to the presence or absence of palpitations on presentation. Clinical characteristics and outcome were analysed. RESULTS: During the 20-year period, 3850 patients were hospitalised for AF; 1724 (44.8%) had palpitations on presentation while 2126 (55.2%) had no palpitations. Patients who lacked palpitations were 9 years older, had a higher prevalence of diabetes mellitus (64.7% vs. 35.3%), underlying coronary artery disease (CAD; 14.6% vs. 6.2%) and severe left ventricular dysfunction on echocardiography (25.5% vs. 6.6%), (all, p = 0.001). There were 141 deaths among the group with no palpitations compared with 19 among the group with palpitations (6.6% vs. 1.1%). Multivariate analysis of mortality predictors identified 'lack of palpitations' as an independent predictor of in-hospital mortality (relative risk 5.56; 95% confidence interval 1.20-25.0, p = 0.03). CONCLUSIONS: Our study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in-hospital outcome independent of other risk factors or therapy. The underlying mechanisms and the role of confounders warrant further investigation.

Pathologic examination of the placenta in human cases of toxoplasmosis.

One hundred sixty one placentae were examined grossly and microscopically, 131 specimens belonged to seropositive patients and 30 specimens belonged to seronegative patients and used as control. 63.3% of the placentae of seropositive patients were macroscopically normal, 9% were hydropic, 21% were of mixed or partially hydropic pattern, 6% had areas of infarction & 0.7% showed areas of calcifications. The most consistent microscopic finding was focal low grade chronic villitis with mononuclear inflammatory infiltrate. In hydropic placentae villous edema was of very variable degree from one placenta to another and from one area to another in the same placenta. Nucleated red blood cells were demonstrated in villous capillaries. The patients had Rh positive factor in their blood.

Comparative study of the Sabin-Feldman dye test and the indirect haemagglutination test in serodiagnosis of toxoplasmosis.

200 women with history of abortion and 100 women with history of uneventful pregnancies were investigated serologically for anti-Toxoplasma antibodies using both the indirect haemagglutination test and the Sabin-Feldman dye test. Our results indicated a role for the first test in seroepidemiological surveys and for routine work. The second test may be reserved for cases with negative haemagglutination test in the presence of strong suspicion of toxoplasmosis.

Synthesis and biological activity of some new 2-(aminoacyl- and dipeptidyl-)aminopyrazine derivatives.

Synthesis of some new 2-(N-tosyl- or N-phthalylaminoacyl or free aminoacyl or N-tosyldipeptidyl- or N-phthalyldipeptidyl)aminopyrazine derivatives (II-XXX) are described. All 2-(aminoacyl)aminopyrazines (XIV-XVIII) have been found to be biologically active against a number of microorganism.

Synthesis and biological activity of some new substituted aminoacyl-carbazole derivatives. Part II.

3-Nitro-9-(N-phthalyl- and N-tosylaminoacyl)carbazoles (II-XI) have been synthesized by the action of 3-nitro-9H-carbazole (I) on N-phthalyl- or N-tosylamino acid in THF-Et3N medium using the DCC method. Treatment of the 3-nitro derivatives (II-XI) with Sn/HCl gave the corresponding 3-amino-9-(N-phthalyl- or N-tosylaminoacyl)carbazoles (XII-XIX). Hydrazinolysis of the N-phthalylcarbazoles derivatives (III-VII) in ethanol gave the corresponding 3-nitro-9-(aminoacyl) carbazoles (XX-XXIII). Compounds (II-XI and XXI, XXII) were found to be active against some microorganisms.

Synthesis of some biologically active substituted thiazole and thiazoline-amino acid derivatives. Part I.

Synthesis of a series of N-(2-acetylaminothiazole-5-sulphonyl) amino acids (II-VI) and some of their corresponding methyl esters (VII-XI) is described. Coupling of N-tosyl-or N-phthalylamino acid with 2-amino-2-thiazoline using the DCC method furnishes 2-(N-tosyl- or N-phthalylamino acyl) amino-2-thiazoline (XII-XXI). Hydrazinolysis of 2-(N-Pht-L-Phe or N-Pht-L-Ala) amino-2-thiazoline in ethanol afforded 2-(L-Phe or L-Ala) amino-2-thiazoline (XXII and XXIII) respectively. Synthesis of the dipeptide 2-(N-Tos-L-Val-L-Leu) amino-2-thiazoline (XXIV) has been achieved employing the azide method. Sixteen thiazole- and thiazoline-amino acid derivatives were found to be active against a number of microorganisms.