19. ALEXANDER KP, SHAW LJ, SHAW LK, DELONG ER, MARK DB, PETERSON ED. Value of exercise treadmill testing in women . J Am Coll Cardiol. 1998; 32 :1657-64.
20. KLIGFIELD P, LAUER MS. Exercise electrocardiogram testing: beyond the ST segment. Circulation. 2006; 114 :2070–2082.
21. MARK DB, SHAW L, HARRELL FE JR, LEE KL, BENGTSON JR, MCCANTS CB, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991; 325 :849–853.
22. GULATI M, ARNSDORF MF, SHAW LJ, PANDEY DK, THISTED RA
Dana Pop, P. Peter, Alexandra Dădârlat, Adela Sitar-Tăut and D. Zdrenghea
Ghrelin, a newly discovered bioactive peptide, was originally reported to induce growth hormone release. Recent studies have shown beneficial hemodynamic effects of ghrelin in the cardiovascular system to support the wide distribution of its receptors in cardiovascular tissues. The aim of the study was to determine whether cardiovascular risk factors influence plasma ghrelin levels.
Methods. We evaluated in the Rehabilitation Hospital Cluj-Napoca, Cardiology - Department 88 consecutive subjects, 65 (73.86%) being women, with mean age 61.7±10.33 years. We assessed the presence of cardiovascular risk factors (obesity, arterial hypertension, diabetes mellitus, metabolic syndrome, smoking and lipid fractions). Plasma ghrelin levels were determined with a commercial ELISA kit (pg/ml).
Results. After the evaluation of cardiovascular risk factors, we found no statistically significant difference between ghrelin levels in the patients with vs those without cardiovascular risk factors (p>0.05). A negative correlation was found between ghrelin levels and age, r = −0.32 (p <0.05). Using the HeartScore Internet tool we calculated the cardiovascular risk for each patient according to the risk score system (SCORE) for high cardiovascular risk countries. Statistically, the risk of fatal cardiovascular events in the next 10 years was indirectly correlated with the ghrelin levels in each patient - correlation between ghrelin levels and SCORE system r=−0.25, p=0.015. In conclusion, low serum ghrelin concentrations are associated with an increased global cardiovascular risk, calculated based on the European SCORE scale. However, we could not demonstrate a direct relationship between any of the major risk factors and ghrelin.
Diana Opincariu, Monica Chițu, Nora Rat and Imre Benedek
The objective of this study was to study the integrated score of ST-segment resolution (ISSTE) and in-hospital death in patients undergoing primary percutaneous intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
Material and Methods: This prospective study included 586 consecutive patients admitted with STEMI to the Cardiology Clinic of the County Emergency Clinical Hospital of Tîrgu Mureș, between January 1st, 2013 and December 31, 2014, who underwent pPCI in less than twelve hours after the onset of symptoms. Clinical and demographic data were analyzed in 539 (91.9%) survivors (Group 1) and 47 (8.1%) nonsurvivors (Group 2). The Integrated Score of ST elevation (ISSTE) was calculated by summing the amplitude of the ST segment elevation in all the 12 leads, before and at 2 hours after revascularization.
Results: The ISSTE score calculated at baseline, immediately before the primary percutaneous coronary intervention, was significantly higher in Group 2 as compared to Group 1 (13.9 ± 1.2 vs. 11.0 ± 0.2, p = 0.026). At the same time, the ISSTE score calculated at 2 hours after the coronary intervention was significantly higher for patients in Group 2 (7.36 ± 1.12 vs. 2.9 ± 0.1, p <0.0001). Analysis of the dynamics of the ISSTE score indicated that patients who survived presented a more expressed reduction in the ISSTE score following pPCI, as compared to those who subsequently died (73.5% reduction in Group 1 compared to 47.2% reduction in Group 2, p <0.0001). In-hospital mortality was significantly higher in the group of patients with >50% reduction in the ISSTE score. The in-hospital death rate was 5.4% in patients with >50% reduction in the ISSTE score, compared to 19.4% for those who presented less than 50% reduction in the ISSTE score following pPCI (p <0.0001). The rate of successful reperfusion rate, expressed by the reduction in ISSTE score, was 83.8% in Group 1, compared to 55.3% in Group 2 (p <0.0001), indicating that the absence of an efficient reperfusion after pPCI is associated with a higher mortality in STEMI patients, and could be evaluated using regression of the ISSTE score, which proved to be directly associated with mortality.
Conclusion: The ISSTE score is shown to be an effective ECG-derived marker of myocardial damage in STEMI patients. A high ISSTE score is associated with higher mortality, while a reduction in the ISSTE score after pPCI may indicate an efficient reperfusion and a decrease in mortality in the first days after infarction.
Shahinul Alam, SKM Nazmul Hasan, Golam Mustafa, Mahabubul Alam, Mohammad Kamal and Nooruddin Ahmad
Only few studies and pilot trials of PTX[ 14 - 16 ] suggested that pentoxifylline reduced plasma TNF- α and IL-6, ALT and AST levels but there is scarcity of data to observe improvement of NAFLD activity score (NAS) and fibrosis score in patients with nonalcoholic steatohepatitis (NASH). The aim of this study was to observe the effect of pentoxifylline on histological activity and fibrosis of Bangladeshi nonalcoholic steatohepatitis patients.
Materials and methods
This study was conducted from August 2014 to December 2015 as an open label Randomized
Syed Mudassir Laeeq, Abbas Ali Tasneem, Farina M. Hanif, Nasir Hassan Luck, Rajesh Mandhwani and Rajesh Wadhva
dysfunction and increased risk of vascular malformation. [ 2 ]
Since GI diseases are common in ESRD patients, multiple studies have been conducted to study the endoscopic findings in this population. Most common reason for endoscopic evaluation has been UGIB. [ 2 , 4 ] Several scoring systems have also been developed to classify patients with UGIB according to their outcome. One such scoring system is the Glasgow Blatchford bleeding Score (GBS), a well-established tool to stratify patients in dire need of intervention from UGIB on the basis of their history, physical
Jawaid Iqbal, Muhammad Ali Khalid, Farina M. Hanif, Rajesh Mandhwani, Syed Mudassir Laeeq, Zain Majid and Nasir Hassan Luck
Stage Liver Disease (MELD) is a validated chronic liver disease (CLD) severity scoring system that includes serum bilirubin, serum creatinine, and the international normalized ratio (INR). An increasing MELD score is associated with progression of hepatic dysfunction, severity and three-month mortality risk.[ 5 ] MELD is also used to prioritize patients on liver transplant waiting list. It is considered better than the Child-Turcotte-Pugh (CTP) score, in part, because of the inclusion of creatinine, which reflects the prognostic impact of renal function.[ 6
Victoria Rus, Diana Opincariu, Roxana Hodas, Tiberiu Nyulas, Marian Hintea and Theodora Benedek
15. Ignacio de Ulibarri J, Gonzalez-Madrono A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20:38-45.
16. Iwakami N, Nagai T, Furukawa TA, et al. Prognostic value of malnutrition assessed by Controlling Nutritional Status score for long-term mortality in patients with acute heart failure. Int J Cardiol. 2017;230:529-536. doi: 10.1016/j.ijcard.2016.12.064.
17. Toyokawa T, Kubo N, Tamura T, et al. The pretreatment Controlling Nutritional Status (CONUT) score is
coronary heart disease is the Framingham risk score (FRS). According to the National Institutes of Health, the patients having chronic kidney disease are considered as having a coronary heart disease risk equivalent, meaning that they are primarily patients with a 10-year risk for myocardial infarction or coronary death >20%, despite without known coronary heart disease. [ 8 ]
Metabolic acidosis, a common condition and an important manifestation of the late stage of chronic kidney disease, leads to clinically significant consequences, including bone disease disorders
Afshin Shafaghi, Faeze Gharibpoor, Zahra Mahdipour and Ali Akbar Samadani
1. SALTZMAN JR., TABAK YP., HYETT BH., SUN X., TRAVIS AC., JOHANNES RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215-24.
2. WADDELL KM., STANLEY AJ. Risk assessment scores for patients with upper gastrointestinal bleeding and their use in clinical practice. Hosp Pract(1995). 2015;43(5):290-8.
3. TAKATORI Y., KATO M., SUNATA Y., HIRAI Y., KUBOSAWA Y., ABE K., et al. The Role of History of Gastro-Duodenal Ulcer in Patients with
, lethargy, impaired intellectual ability, and so on in end-stage coma (with or without response to stimuli) and later death in severe cases. [ 4 , 5 , 6 , 7 ] The neuropsychological peculiarity can be revealed by the use of psychometric tests, for instance, neuropsychological tests such as Halstead-Reitan (H-R) score and Child-Pugh score or other psychometric tests. [ 8 , 9 , 10 ] There is no gold standard test to diagnose HE due to the personal peculiarities of each case. That is why physicians mostly rely on their personal experiences, equipment availability, and