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Background: This study was an attempt to evaluate the knowledge and awareness among dentists about COVID-19 infection. Methodology: This study was conducted among 580 dental professionals that comprised graduates (BDS), masters (MDS), postgraduates, and PhD fellows. A questionnaire containing information about knowledge, attitude, and awareness about COVID-19 infection was administered and recorded. Results: A total of 493 (85%) respondents replied correct answer that SARS-CoV-2 causes COVID-19. A total of 464 (80%) respondents replied that SARS-CoV-2 is the highest infectious virus among all. A total of 510 (88%) respondents replied the correct answer that 2–14 days is the incubation period of COVID-19 virus. Only 116 (20%) respondents replied the correct answer that MERS has high mortality. Only 87 (15%) respondents were aware of the appropriate mortality rate of COVID-19 disease. A total of 455 (78.4%) respondents had knowledge of the method of detecting COVID-19 infection (real-time reverse transcription-polymerase chain reaction). Knowledge level was good as seen in 81%, fair in 9.5%, and poor in 10.5% of the respondents. Conclusion: The authors found that dental professionals had fair knowledge and awareness regarding COVID-19 infection.

Background Changes in brain structure and cognitive decline occur in Chronic Obstructive Pulmonary Disease (COPD). They also occur with smoking and coronary artery disease (CAD), but it is unclear whether a common mechanism is responsible. Methods Brain MRI markers of brain structure were tested for association with disease markers in other organs. Where possible, principal component analysis (PCA) was used to group markers within organ systems into composite markers. Univariate relationships between brain structure and the disease markers were explored using hierarchical regression and then entered into multivariable regression models. Results 100 participants were studied (53 COPD, 47 CAD). PCA identified two brain components: brain tissue volumes and white matter microstructure, and six components from other organ systems: respiratory function, plasma lipids, blood pressure, glucose dysregulation, retinal vessel calibre and retinal vessel tortuosity. Several markers could not be grouped into components and were analysed as single variables, these included brain white matter hyperintense lesion (WMH) volume. Multivariable regression models showed that less well organised white matter microstructure was associated with lower respiratory function (p = 0.028); WMH volume was associated with higher blood pressure (p = 0.036) and higher C-Reactive Protein (p = 0.011) and lower brain tissue volume was associated with lower cerebral blood flow (pp = 0.001). Smoking history was not an independent correlate of any brain marker. Conclusions Measures of brain structure were associated with a range of markers of disease, some of which appeared to be common to both COPD and CAD. No single common pathway was identified, but the findings suggest that brain changes associated with smoking-related diseases may be due to vascular, respiratory, and inflammatory changes.

Background The combined left atrial appendage closure (LAAC) and cryoenergy pulmonary vein isolation (PVI) procedure has been proven safe and effective in managing stroke in patients with nonvalvular atrial fibrillation (AF), although most data refer to procedures performed using radiofrequency as the main energy source. Objective The purpose of this study was to evaluate long-term follow-up of patients with AF undergoing concomitant LAAC and cryoenergy PVI. Methods Patients undergoing LAAC and cryoballoon PVI at our institution were enrolled. At 3, 6, and 24 months from the index procedure, we determined the atrial arrhythmia recurrence rate, the extent of LAAC, and the rate of cerebrovascular/bleeding events. Results Forty-nine patients (mean age 69 ± 8 years; 32/49 (67%) men; CHA2DS2-VASc score 2.8 ± 1.2; HAS-BLED score 3 ± 1) with a guideline-recommended LAAC indication were included. Acute PVI and complete LAAC were achieved in 100% of patients. All patients completed at least 24 months of follow-up. At 8 weeks and 6 months, complete or satisfactory ( Conclusion Concomitant cryoballoon ablation and LAAC procedures appear safe and effective at long-term follow-up, with high antithrombotic drug withdrawal rates at 24 months.

Background The survival outcome of transplant patients have improved in the past three decades. The short and long term survival of graft and patients are still being widely studied. Many factors affect the survival rate such as age, gender, diabetes mellitus, and immunosuppressive therapy. Objective The study aim to provide patients’ survival rates 1, 3, and 5 years after transplant. Methods The study used descriptive approach on 67 kidney transplant patients undergoing outpatient treatment from 1996 to 2016. The data collected was analyzed using SPSS with the Kaplan-Meier curve to observe the survival rate. Result The survival rate of patients in 1, 3, and 5 years were 100%, 97%, and 94% respectively. The survival rate in geriatric and non-geriatric patients in the first year post-transplantation was both 100%, the third year post-transplantation survival rate were 100% and 94.7%, and the five year post-transplantation survival rate were 100% and 89.5%. The 1, 3, and 5 year survival rate for male and female patients were both 100%, 96.3% vs 100%, and 92.6% vs 100% respectively. Compared to their non-diabetic counterparts, diabetic patients’ survival rate in 1, 3, and 5 years were both 100%, 96.5% vs 100%, and 93% vs 100% respectively. The survival rate of patients receiving tacrolimus vs cyclosporine were both 100% in the first year, 97.1% vs 97% in the third year, and 97.1% vs 90.9% in the fifth year after transplant. Conclusion The survival rate of kidney transplant patients in 1, 3, and 5 year after transplant were 100%, 97%, and 94%. Factors linked to higher survival rate were geriatric patients, female gender, diabetes, and the use of cyclosporine in the immunosuppressant therapy regimen. Keyword: kidney transplantation, survival

Background Brain damage and cardiovascular disease are extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD). Cardiovascular risk factors and smoking are contributors to neurodegeneration. This study investigates whether there is a specific, COPD-related deterioration in brain structure and function independent of cardiovascular risk factors and smoking. Materials and methods Neuroimaging and clinical markers of brain structure (micro- and macro-) and function (cognitive function and mood) were compared between 27 stable COPD patients (age: 63.0±9.1 years, 59.3% male, forced expiratory volume in 1 second [FEV1]: 58.1±18.0% pred.) and 23 non-COPD controls with >10 pack years smoking (age: 66.6±7.5 years, 52.2% male, FEV1: 100.6±19.1% pred.). Clinical relationships and group interactions with brain structure were also tested. All statistical analyses included correction for cardiovascular risk factors, smoking, and aortic stiffness. Results COPD patients had significantly worse cognitive function (p=0.011), lower mood (p=0.046), and greater gray matter atrophy (p=0.020). In COPD patients, lower mood was associated with markers of white matter (WM) microstructural damage (p

IL-6 is a proinflammatory cytokine that is commonly obtained in chronic kidney disease (CKD) patients and has a role in insulin resistance. This study aimed to determine the correlation between IL-6 and insulin resistance in non-diabetic predialysis CKD patients. Methods: The cross sectional observational analytic study involved 35 subjects as CKD patients with non-diabetic predialysis who were diagnosed based on KDOQI criteria. Examination of serum IL-6 levels was carried out using the ELISA method, and insulin resistance was calculated using the HOMA-IR formula. Results: Thirty-five non-diabetic predialysis CKD patients were enrolled in this study, consisting of 25 (71.4%) males and 10 (28.6%) females. The mean age was 52.5 years (range of 31-60 years). Subjects with stage 3 CKD was 11 patients (31.4%), stage 4 was 6 patients (17.14%), and stage 5 was 18 patients (51.43%). HOMA-IR level was 1.61±1.13 with a median of 1.15 (0.32-4.59). Levels of IL-6 had a mean of 9.03 ± 7.01 and a median of 8.13 (1.01-24.82). There was a significant positive correlation between IL-6 levels and insulin resistance (p = 0.031, r = 0.366) Conclusion: Serum IL-6 levels had a significant positive correlation with insulin resistance in CKD patients with non-diabetic predialysis.

Aim. This study sought to compare short- and long-term outcomes of drug-eluting stents (DESs) versus bare-metal stents (BMSs) implantation in patients with end-stage renal disease on hemodialysis (ESRD-HD) undergoing percutaneous coronary intervention (PCI). Methods. Adult patients with ESRD-HD who underwent PCI at all nonfederal hospitals in Massachusetts between July 1, 2003, and September 30, 2007, were stratified based on the stent type placed at index hospitalization: DES or BMS. The primary outcome compared was a composite of all-cause death, myocardial infarction (MI), congestive heart failure (CHF), target vessel revascularization (TVR), and stroke at 30 days and one year. Results. HD patients had a high mortality (31%) and were more likely to receive a DES than a BMS (77% versus 23%). Propensity score analysis of 2 : 1 matched DES (268) versus BMS (134) patients demonstrated the DES group to more likely have proximal LAD disease and a history of prior PCI. Conditional logistic regression analysis demonstrated no significant difference in the composite cardiovascular endpoint measured at 30 days (hazard ratio (HR) 1.09; 95% confidence interval (CI) 0.61–1.94) and one year (HR 1.03; 95% CI 0.68–1.57). Conclusions. There were no significant differences in 30-day or 1-year major cardiovascular outcomes in HD patients undergoing PCI using the DES compared to the BMS in this high-mortality patient cohort.

Background : Urinary tract tuberculosis (TB) is one type of extrapulmonary TB. The prevalence in developed countries is around 15-20% of all cases of extrapulmonary TB. 1 The insidious onset and non-specific constitutional symptoms of urinary tuberculosis often lead to delayed diagnosis and rapid progression to a non-functioning kidney. 2-3 The only way to limit renal function loss and destruction is by early diagnosis and therapy. 4 Case: 34-year-old woman, came with complaints of urinary pain accompanied by right flank pain 10 months prior. Patient also had complaint of weight loss but ignoring complaints of night sweats. Patient repeatedly diagnosed as a urinary tract infection and received many kinds of antibiotic therapy but her complaints were not getting better. Urine production was about 1700 cc/24 hours. From general physical examination, there was a lack of nutritional status with BMI 17.1 kg/m2. Vesicular lung sound without rhonchi heard in both lung fields. From the urinalysis examination there were pyuria and haematuria without bacteriuri. Laboratory examination showed value of BUN was 17 mg/dl and creatinine 0.9 mg/dl. From aerob urine culture we found sterile urine. But we found positive result of Mycobacterium tuberculosis (MTB) urine cultures which was sensitive to isoniazid, rifampicin, pyrazinamide, and ethambutol. Abdominal ultrasound showed severe ecstasis of right pelviocalyceal system without stones,mass, nor cyst. We had additional data from intravenous pyelogram (IVP) which showed a non-visualized dextra pelviocalyceal system and delayed bladder emptying function at 120 th minutes. From computed tomography stonographic, we found severe right hydronephrosis, proximal to distal right hydroureter, and thickening of bladder wall (± 1.61 cm) on the right antero-lateral side. To find out the cause of thickening of bladder wall, we did bladder biopsy which showed the mononuclear inflammatory cell stroma. Patients were diagnosed with urinary tract TB and received category 1 of oral anti tuberculosis therapy (Rifampicin, Isoniazid, Pyrazinamid, and Ethambutol) for 12 months and underwent right DJ stent implantation to manage the ectasys. Conclusion : Urinary tract TB often showed unspecified complaints and can be suggested as recurrent urinary tract infections. Early diagnosis and optimal management were needed to prevent anatomical and functional complications.

Mohani-Preet K Bajaj,1 Daniel R Burrage,2 Andrew Tappouni,3 James W Dodd,4 Paul W Jones,2 Emma H Baker2 1Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK; 2Clinical Pharmacology, Institute of Infection and Immunity, St George’s University of London, London, UK; 3St George’s University of London, London, UK; 4Academic Respiratory Unit, University of Bristol, Bristol, UK Purpose: People with COPD have cognitive dysfunction, which is greater in those hospitalized for exacerbations than in stable outpatients. We tested the hypothesis that cognitive dysfunction at exacerbation is a disease-specific feature of COPD, rather than a nonspecific feature of hospitalization for acute illness, by comparing cognition between patients hospitalized for acute COPD exacerbations and those with worsening heart failure (HF). Patients and methods: A total of 40 hospital inpatients were recruited, 20 patients with COPD exacerbations and 20 patients with congestive or left-sided HF. Exclusion criteria included previous stroke, known neurological disease, and marked alcohol excess. Participants completed the Montreal cognitive assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) and underwent spirometry and review of clinical records. Results: Age (mean±SD, COPD 73±10; HF 76±11years), acute illness severity (Acute Physiology and Chronic Health Evaluation [APACHE]-II, COPD 15.4±3.5; HF 15.9±3.0), comorbidities (Charlson index, COPD 1.3±1.9; HF 1.6±1.5), and educational background were similar between COPD and HF groups. MoCA total was significantly lower in COPD than in HF (COPD 20.6±5.6; HF 24.8±3.5, P=0.007); however, significance was lost after correction for age, sex, and pack year smoking history. When compared with HF patients, the COPD cohort performed worse on the following domains of the MoCA: visuospatial function (median [IQR], COPD 0 [1]; HF 2 [1], P=0.003), executive function (COPD 2 [1]; HF 3 [1], P=0.035), and attention (COPD 4 [3]; HF 6 [2], P=0.020). Age (P=0.012) and random glucose concentration (P=0.041) were associated with cognitive function in whole group analysis, with pack year smoking history reaching borderline significance (P=0.050). Conclusion: Total MoCA score for COPD and HF indicated that both groups had mild cognitive impairment, although this was greater in people with COPD. Mechanisms underlying the observed cognitive dysfunction in COPD remain unclear but appear related to blood glucose concentrations and greater lifetime smoking load. Keywords: Montreal cognitive assessment, cognition, comorbidities, systemic, smoking, hyperglycemia

Background: COPD, cardiovascular disease and structural brain disease commonly coexist, but the relative contributions of COPD and cardiovascular disease to structural brain disease is unclear. Aim: The aim of this study was to determine the association between two different COPD phenotypes and structural brain disease. Methods: COPD patients were recruited from two populations. Group 1 were recruited from people attending for elective coronary angiography who had no exacerbations in the preceding year. Group 2 were recruited from people attending the respiratory outpatient department who had had at least 1 exacerbation in the preceding year. Participants underwent measurement of Framingham score (10-year risk of cardiovascular event), spirometry, arterial stiffness, skin capillary density, cardiac biomarkers, systemic inflammatory markers and structural brain MRI. Results: Group 1 had mild/moderate COPD with significantly higher cardiovascular risk whereas group 2 had moderate/severe COPD with lower cardiovascular risk (FEV1 % predicted 78±19 v 54±24 p Conclusion: Cardiovascular risk, rather than respiratory health, appears more strongly associated with white matter brain disease in these two groups of patients with COPD.

Background The radial artery is the access of choice in many catheterization labs around the world due to its proven benefits over the femoral artery access. There has been growing interest in the left radial artery. We sought to evaluate the feasibility, safety and complication rates of the left distal radial artery (ldTRA) access for cardiac catheterization. Methods This is a single arm retrospective study evaluating the feasibility and safety of performing cardiac catheterization through ldTRA. The procedure was completed using standard diagnostic and guiding catheters. Hemostasis was achieved with a radial band. Feasibility was the ability to cannulate the distal left radial artery as well as completing the procedure without requiring an additional arterial access. The safety point included hematoma, bleeding or neuropathy. Results ldTRA was attempted in 61 patients. 59 patients had successful completion of the procedure through ldTRA. Conversion occurred in 1 patient (1.7%), requiring an additional arterial access to complete the procedure. 34 patients (55.7%) required percutaneous coronary intervention (PCI). There was no access site bleeds post procedure, no hematomas, with 100% successful hemostasis with a radial hemostatic band. There were 2 cases requiring reaccess of the distal left radial artery access for repeat revascularization, with procedure success and good left radial artery patency. Conclusion ldTRA is a safe and feasible arterial access in a radial experienced catheterization lab. ldTRA provides improved operator ergonomics and patient's comfort, in addition to the advantage of being able to cannulate the bypass grafts and with a very low risk of vascular complications.

Background— Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases. Methods and Results— We performed endocardial bipolar EVM-guided EMBs in 29 patients and we analyzed unipolar EVM at withdrawal sites. Eighty myocardial samples were collected (mean, 2.8±0.9; median, 3 fragments per patient) and 60 were suitable for histological analysis. Ten specimens (17%) were collected from an area with discordant normal bipolar/low-voltage unipolar EVM and they were diagnostic or suggestive for arrhythmogenic right ventricular dysplasia/cardiomyopathy in 6 patients, for myocarditis and sarcoidosis in 1 patient each. Six samples (10%) were collected from an area with discordant low-voltage bipolar/normal unipolar EVM and they showed nonspecific features. The sensitivity of unipolar EVMs for a diagnostic biopsy finding EMB was significantly higher compared with bipolar EVMs analyzed according to samples ( P P =0.008). The specificity of unipolar EMB was better than bipolar EMB when analyzed for all samples ( P =0.0014) but the difference did not reach statistical significance when analyzed by patient ( P =0.083). The diagnostic yield was 63.3% for the bipolar and 83.3% for the unipolar EVM. Conclusions— These findings suggest that use of a combined bipolar/unipolar map may be able to improve the diagnostic yield of endomyocardial ventricular biopsy.

Background: The combination of ankle brachial index (ABI) and other risk stratification tools has been evaluated previously. However baseline ABI in patients admitted for chest pain prior to stress testing to predict increased probability of abnormal stress test and MACE (major cardiovascular adverse events) has not been studied. Methods: Patients (n= 342) admitted for chest pain with normal or unchanged electrocardiogram and negative troponin T who were referred for myocardial perfusion study were enrolled in this prospective observational study and followed for one year. The first part of the study was to assess if an abnormal ABI increases the probability of an abnormal stress test and the second part was to measure one-year outcome for MACE (Angina, MI, CHF, TIA/Stroke and deaths) based on their stress test and ABI results. Multivariable logistic regression modeling is used to interpret the data. Results: In our study population 83% of the patients had Framingham risk score less than 20. Twenty-nine percent of the patients with normal ABI and 40% of the patients with abnormal ABI had abnormal stress test. The difference is statistically insignificant. After adjusting for different variables abnormal ABI was found to have stronger correlation with MACE (Odds ratio 2.9, p 0.01, CI 1.2 - 6.7) as compared to abnormal stress test (Odds ratio 0.92, p 0.84 CI 0.3 - 2.1). Conclusion: In our study cohort an abnormal ABI, irrespective of the stress test results, was an independent predicator of MACE at one year. We can conclude that there is very weak temporal relationship between abnormal ABI and abnormal stress test in low risk population and asymptomatic peripheral vascular disease is a strong independent predictor of MACE, even in this low risk population. We can also conclude that ABI during stress testing can be used for risk stratification. Future studies may need more power in this low risk population.

The radial artery is the access of choice in many catheterization labs around the world due to its proven benefits over the femoral artery access. Though the right radial artery is the preferred side, there has been growing interest in utilizing the left radial especially in patients with bypass

Hepatitis C virus infection is highly prevalence in chronic hemodialysis (HD) patients. The present study will compare prevalence of HCV positive population in difference countries where there are great contrasts in and diversity of care available to patients who have end stage renal disease. All serum samples of the 100 patients were tested for HCV antibodies, using third-generation enzyme immunoassay. The prevalence of anti-HCV was correlated with a history of blood transfusion and with duration of hemodialysis. HCV prevalences were 88% of Surabaya group and 6% of Juntendo Group, respectively. In Surabaya Group, prevalence of HCV positive was high and the risk factors are not only those of the Juntendo Group, but also a combination of poor living conditions, frequent blood transfusions, and lack of adherence. Much needs to be studied about the role of universal screening and effective techniques for primary prevention in Surabaya Group

Aims Electrical storm is an emergency in ‘implantation of a cardioverter defibrillator’ carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence. Methods We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days. Results Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1%), repeated procedures were needed, including epicardial ablation in 3/26 (11.5%). In 23/26 patients (88.5%), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2%) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5%) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset. Conclusion In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.

Electrical storm (ES) is one of the most challenging clinical scenarios facing electrophysiologists, and in certain settings emergency ablation should be performed. The majority of ES occurs in patients with structural heart disease, predominantly coronary heart disease and nonischemic heart disease like right ventricular arrhythmogenic dysplasia and previous myocarditis as well as other cardiomyopathies. Implantable cardioverter-defibrillators (ICDs) are the first-line therapy in patients with ventricular tachycardia (VT) and structural heart disease. Recurrent VT episodes or ES are major problems in patients who receive an ICD after a spontaneous sustained VT. In addition, in patients with an ICD implanted for primary prevention of sudden cardiac death, 20 % will experience at least one VT episode within 3–5 years after ICD implantation. Catheter ablation has a high success rate in the acute setting in eliminating clinical VT. However, several factors make enodocardial catheter ablation of VT more difficult especially in advanced ischemic heart disease with heart failure and aneurysm. Frequently in nonischemic cardiomyopathies (NICM) there tends to be an epicardial and intramyocardial substrate where the critical VT zone can occasionally be epicardial or intramural in location. In some patients, an epicardial approach should be warranted first together with an endocardial approach or after failure of enodocardial ablation. Currently, the success rates of endocardial ablation in the acute setting are acceptable, but in the long term they are still not well defined. The purpose of this article is to highlight the importance of epicardial ablation as an alternative approach in controlling ES and to confirm the need for highly qualified centers to manage such challenging cases.

Background: Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation ablation performed with different technologies. Methods and Results: One hundred and ten patients were treated with pulmonary vein isolation with 4 different technologies: open-irrigated tip radiofrequency (RF) catheter in35 patients (Group A), cryoballoon in 35 patients (Group B), visually guided laser balloon in 20 patients (Group C), open-irrigated tip RF catheter with contact-force-sensing technology in 20 patients (Group D). Post-procedure samples of cardiac troponin I (cTnI) and creatinine kinase-MB (CK-MB) were collected at 19 ± 3 h and 43 ± 3 h after ablation. At the first postprocedural sample, cTnI and CK-MB levels were found elevated in all 110 patients with a median value of 2.11 ng/mL and 8.95 ng/mL, respectively. Group B showed cTnI levels increased (median 5.96 ng/mL) compared to other groups (median Group A: 1.72 ng/mL, Group C: 1.54 ng/mL, Group D: 2.0 ng/mL; p < 0.001). Also CK-MB levels resulted higher in cryoablation (median 26.4 ng/mL) compared to other groups (median Group A: 6.40 ng/mL, Group C: 7.15 ng/mL, Group D: 6.50 ng/mL; p < 0.001). No significant association was observed between biomarker levels and recurrences of atrial fibrillation after a mean follow-up of 369 ± 196 days. Conclusions: Highest markers for myocardial injury were observed in the cryoballoon group. It is possible that a longer delivery energy duration and other factors affecting lesion size resulted in higher amount of cardiac injury in cryoablation. The higher levels of cardiac biomarkers did not translate into a better outcome and its physiologic significance is unknown.

Background. Hepatitis C virus (HCV) represents a major worldwide public health problem. Though several studies from Yemen have provided an estimate of the prevalence of this viral infection, there exist only few studies which reflect the status in the general population. Aim. The present study was designed to investigate the prevalence of hepatitis C infection among general population in central region of Yemen. Methods. The study population comprised 2,379 apparently healthy subjects who were screened for hepatitis C antibodies (HCV Abs) status using ELISA quantitative technique. Seroprevalence rate of seropositive subjects was calculated and stratified by age, sex, educational level, and monthly income. Results. The study showed that out of 2,379 subjects, 31 (1.3%) were HCV Abs positive. Higher prevalence of HCV Abs was found among females, 24 (1.01%), than males, 7 (0.29%). The age specific prevalence rose from 00 (0.00%) in subjects aged ≤14 years to a maximum of 9 (0.38%) in subjects aged ≥55 years. The prevalence of HCV Abs was more prevalent in illiterate subjects and increased with decreasing monthly income. Conclusion. It was found that variables including age and educational level were significantly associated with HCV Ab positivity and not associated with gender and monthly income.

Post-infarction patients with severe left ventricular dysfunction are at high risk of sudden cardiac death. Antiarrhythmic therapy does not improve survival in such patients and, therefore, implantable cardioverter defibrillators (ICD) emerged as treatment of choice for both primary and secondary prevention of mortality after myocardial infarction (MI). The MADIT (Multicenter Automatic Defibrillator Implantation Trial) (1), and MUSTT (Multicenter Unsustained Tachycardia Trial) trials (2) were the first primary prevention ICD trials documenting a substantial reduction in mortality with an ICD in postinfarction patients with depressed ejection fraction, nonsustained ventricular tachycardia, and inducible sustained ventricular tachycardia. The MADIT II trial broadened the indications for prophylactic ICD use in post-infarction patients with ejection fraction of 30% or less without a requirement for additional risk stratification (3). The benefit from ICD therapy in patients with low ejection fraction was recently confirmed by results from the SCD-HeFT (Sudden Cardiac Death in Heart Failure) (4) and COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trials (5).

In this paper we describe the management of ICD (implantable cardioverter defibrillator) carriers who undergo extraction of infected leads and who, in view of the need for sameside reimplantation, are studied with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET-CT) scan, or with leukocyte technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) scan before reimplantation, in order to rule out a residual infection at the site of original implantation.

A 60-year-old man presented with congestive heart failure and was diagnosed with cor triatriatum after echocardiography. The various imaging modalities used for the definitive diagnosis of this condition are reviewed.

Background In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state. Methods Cross sectional analyses of the National Family Health Survey – 2 dataset. Setting Maharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery. Results A majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery. Conclusion As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.

Background and Aim: Despite the multitude of evidence on the deteriorating effect of smoking on lung function and lung age, less attention was devoted to the use of such effects as an effective strategy to quit smoking. Therefore, in this study, we aim to determine the predictability of waist circumference (WC) and body mass index (BMI) for pulmonary function and lung age in normal weight young adult smokers and nonsmokers. Methods: One hundred and thirteen smokers and 95 nonsmoker control male students of Taif University were recruited. Pulmonary function tests including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, and forced expiratory flow 25-75% (FEF25-75%) were performed by each student to measure the lung age. Anthropometric measurements included WC and BMI were performed. Results: We found a significant lower mean value of FVC, FEV1/FVC ratio, and FEF25-75% in smokers as compared to mean values of age-matched nonsmoker students. Furthermore, the results revealed a significant increase in lung age of smokers as compared to that of nonsmoker students. In smoker subjects, FEV1, FVC, and FEF25-75% are correlated negatively with WC of the subject while their lung age correlated positively with WC. Conclusion: There is a significant deteriorating effect of smoking on lung function on lung age. WC appears to be a better predictor of pulmonary function and lung age than BMI in normal weight young adults.

Single dose of 1 and 3 mg/kg endosulfan did not show any significant effect on binding of 3H-serotonin to frontal cortical membranes as well as on foot-shock-induced fighting behaviour in rats, where as repeated exposure of endosulfan (3 mg/kg for 30 days) caused a significant increase in 3H-serotonin binding. Scatchard analysis showed an increase in the affinity of the receptor (KD) in the treated animals while number of receptor sites (Bmax) remained unaltered. Long term endosulfan exposure caused aggressive behaviour (foot-shock-induced fighting behaviour) which was blocked by methysergide, a 5-HT blocker. These results indicate the involvement of serotonergic receptors in endosulfan neurobehavioral toxicity.