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   2012| April-June  | Volume 13 | Issue 2  
    Online since August 1, 2012

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Pregnancy-related spontaneous coronary artery dissection: Two case reports and a comprehensive review of literature
Azeem S Sheikh, Michael O'Sullivan
April-June 2012, 13(2):53-65
DOI:10.4103/1995-705X.99229  PMID:22919449
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, particularly seen in women during pregnancy or in the puerperium. It has a high acute phase mortality. The etiology is uncertain. Hormonal changes during pregnancy, hemodynamic stress and changes in the autoimmune status have been considered as possible etiological factors. A timely diagnosis and institution of appropriate treatment is important for a successful outcome. There is no consensus of opinion for optimal treatment. Conservative management, coronary artery bypass graft surgery, and percutaneous coronary intervention, all have been described in the literature as possible therapeutic options. Spontaneous coronary artery dissection should be considered as a differential in any young woman presenting with chest pain associated with pregnancy. We report two cases of pregnancy-associated spontaneous coronary artery dissection, both successfully managed, along with a comprehensive review of the previously published literature.
  13,666 219 28
Giant left atrium: A review
Ahmed El Maghraby, Rachel Hajar
April-June 2012, 13(2):46-52
DOI:10.4103/1995-705X.99227  PMID:22919448
Giant left atrium is a rare condition, with a reported incidence of 0.3%, and following mainly rheumatic mitral valve disease. Although rheumatic heart disease represents the main cause of giant left atrium, other etiologies have been reported. Giant left atrium has significant hemodynamic effects and requires specific management. In this review, we present two cases, discuss the different definitions, etiologies, clinical presentation and management modalities.
  10,422 344 11
Clinical profile and mortality of ST-Segment elevation myocardial­ infarction patients receiving thrombolytic ­Therapy in the Middle East
Prashanth Panduranga, Ibrahim Al-Zakwani, Kadhim Sulaiman, Khalid Al-Habib, Jassim Al Suwaidi, Ahmed Al-Motarreb, Alawi Alsheikh-Ali, Shukri Al Saif, Hussam Al Faleh, Wael Almahmeed, Nidal Asaad, Haitham Amin, Jawad Al-Lawati, Ahmad Hersi
April-June 2012, 13(2):35-41
DOI:10.4103/1995-705X.99224  PMID:22919446
Objective: Little is known about thrombolytic therapy patterns in patients with ST-elevation myocardial infarction (STEMI) in the Middle East. The objective of this study was to evaluate the clinical profile and mortality of STEMI patients who arrived in hospital within 12 hours from pain onset and received thrombolytic therapy. Patients and Methods: This was a prospective, multinational, multi-centre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in six Middle Eastern countries during the period between October 2008 and June 2009, as part of Gulf RACE-II (Registry of Acute Coronary Events). Analyses were performed using univariate statistics. Results: Out of 2,465 STEMI patients, 66% (n = 1,586) were thrombolysed with namely: streptokinase (43%), reteplase (44%), tenecteplase (10%), and alteplase (3%). 22.7% received no reperfusion. Median age of the study cohort was 50 (45-59) years with majority being males (91%). The overall median symptom onset-to-presentation and door-to-needle times were 165 (95- 272) minutes and 38 (24-60) minutes, respectively. Generally, patients presenting with higher GRACE risk scores were treated with newer thrombolytic agents (reteplase and tenecteplase) (P < 0.001). The use of newer thrombolytic agents was associated with a significantly lower mortality at both 1-month (0.8% vs. 1.7% vs. 4.2%; P = 0.014) and 1-year (0% vs. 1.7% vs. 3.4%; P = 0.044) compared to streptokinase use. Conclusions: Majority of STEMI patients from the Middle East were thrombolysed with streptokinase and reteplase in equal numbers. Nearly one-fifth of patients did not receive any reperfusion therapy. There was inappropriately long symptom-onset to hospital presentation as well as door-to-needle times. Use of newer thrombolytic agents in high risk patients was appropriate. Newer thrombolytic agents were associated with significantly lower mortality at 1-month and 1-year compared to the older agent, streptokinase.
  4,786 272 5
Vitamin E and Omega-3: What to believe: Observational studies or randomized controlled trials?
Mostafa Yakoot
April-June 2012, 13(2):66-68
DOI:10.4103/1995-705X.99230  PMID:22919450
The practice of conventional medicine has markedly changed since the introduction of the concept of the evidence-based medicine. Randomized controlled study design and large sample size were the only justifications for level A or B evidence at the summit of what is called the evidence pyramid. A lot of medical interventions that were based on a plethora of basic researches and multiple large real world or observational studies in humans became questioned now by the results of even a single large sized randomized controlled trial (RCT). The conflicting evidences for the value of vitamin E and Omega-3 fatty acids in cardiovascular diseases are famous examples for such perplexity. This article discusses this problem on the basis of scientific, ethical, and statistical critical appraisal. To conclude, in this era of overwhelming flow of data, it should be emphasized in short, fast-to-read articles that it is important to consider not only the level of evidence "as dictated by the study design and sample size" but also the relevance of evidence. Studies tell us about populations but we treat individuals. The type of the studied individuals, the enrollment criteria, the methodology, the dose of the studied drug and all the combined medications in the study should be clearly considered whenever the reported results are to be generalized beyond the specific situation studied. Comparing the effect of an active drug against placebo by giving either one of them to a group already treated with other multiple drugs (optimum medical therapy) could be a misleading indicator for the pure efficacy of the active drug. Many confounding variables such as known "or unknown" drug-drug interactions, sharing mechanisms of action or unexpected adverse drug reactions can afflict only the group randomized to take the active drug. These variables will not affect the control group simply because they add to their optimized multiple drug therapy an inert placebo.
  3,972 198 2
Left main coronary artery aneurysm: A rare presentation
Monika Maheshwari, Chandra Prakash Tanwar, SR Mittal
April-June 2012, 13(2):69-70
DOI:10.4103/1995-705X.99231  PMID:22919451
Left main coronary artery aneurysm is an uncommon coronary anomaly. We describe herein a male whose coronary angiogram revealed left main coronary artery aneurysm. The purpose of the case report is to highlight the clinical picture, workup, and treatment options for such patients.
  3,532 150 -
Evaluation of QT interval in β thalassemia major patients in comparison with control group
Behzad Farahani, Mohammad Amin Abbasi, Isa khaheshi, Koosha Paydary
April-June 2012, 13(2):42-45
DOI:10.4103/1995-705X.99226  PMID:22919447
Background: Cardiac complications are the primary cause of death in patients with b thalassemia major. QTc interval is an indicator of variability of ventricular repolarization and is supposed to be prominent in high risk patients. The aim of this investigation was to evaluate the relationship between QTc interval in β thalassemia major in comparison with the control group. Patients and Methods: Sixty β thalassemia major and intermadia patients were enrolled in this analytical cross-sectional study. Thalassemia major and intermadia patients with no clinical symptoms of cardiac disease underwent echocardiographic and stress tests. QTc interval, blood pressure, heart rate, and average serum ferritin levels were measured. Statistical analysis was performed using version 15 SPSS. Results: Although there was no clinical or echocardiographic sign of cardiac disease and QTc intervals measured before the test were not significantly different between patients and control group (421.7 ± 29.6 vs. 412.4 ± 28.2, P = 0.06), we found that, during stress test, QTc intervals (452.7 ± 30.8 vs. 410.2 ± 26.2, P < 0.001) and heart rate (105 ± 15.1 vs. 89.7 ± 12.3, P < 0.001) were notably greater in β thalassemia major patients compared to the control group, respectively. Conclusion: We found augmented QTc intervals in this group of thalassemia major patients who have neither clinical nor electrocardiographic and gross echocardiographic signs of cardiac disease. QTc interval can be helpful in the cardiac assessment of thalassemia major patients.
  3,326 155 3
Classics in Cardiology: On Cardiac Murmurs* (Part 3)
Austin Flint
April-June 2012, 13(2):77-83
DOI:10.4103/1995-705X.99236  PMID:22919455
  3,283 116 2
Arab folk medicine and magic

April-June 2012, 13(2):75-76
  3,152 75 -
Successful pregnancy in a patient with univentricular heart and pulmonary stenosis
Angadi Rajasab Nilofer, Syed Ahmed Zaki
April-June 2012, 13(2):71-73
DOI:10.4103/1995-705X.99232  PMID:22919452
Univentricular heart or single ventricle heart is a rare and complex congenital heart disease (CHD). We report the successful management of a parturient with a single ventricle, and pulmonary stenosis. The univentricular heart is discussed in detail and the maternal and fetal outcome in pregnant women with CHD is reviewed.
  2,884 111 3
Massive calcification in the myocardium post infarction
Prathamesh V Joshi, Vikram R Lele, Hina J Shah, Sheila Rao
April-June 2012, 13(2):74-74
DOI:10.4103/1995-705X.99233  PMID:22919453
  2,477 102 1