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Ekiti State, Nigeria

Bahorun T.,University of Mauritius | Luximon-Ramma A.,University of Mauritius | Neergheen-Bhujun V.S.,University of Mauritius | Gunness T.K.,Cardiac Center | And 4 more authors.
Preventive Medicine | Year: 2012

Objectives: A prospective randomized controlled clinical trial determined the effect of Mauritian black tea consumption on fasting blood plasma levels of glucose, lipid profiles and antioxidant status in a normal population. Methods: The study group (71%) consumed 3 x 200. ml of black tea infusate/day for 12. weeks without additives followed by a 3. week wash-out. The control group (29%) consumed equivalent volume of hot water for same intervention period. Results: The tea used had high levels of gallic acid derivatives (50 ± 0.4. mg/L), flavan-3-ols (42 ± 2. mg/L), flavonols (32 ± 1. mg/L) and theaflavins (90 ± 1. mg/L). Daily 9. g supplementation of black tea infusate induced, in a normal population, a highly significant decrease of fasting serum glucose (18.4%; p < 0.001) and triglyceride levels (35.8%; p < 0.01), a significant decrease in LDL/HDL plasma cholesterol ratio (16.6%; p < 0.05) and a non significant increase in HDL plasma cholesterol levels (20.3%), while a highly significant rise in plasma antioxidant propensity (FRAP: 418%; p < 0.001) was noted Conclusion: Black tea consumed within a normal diet contributes to a decrease of independent cardiovascular risk factors and improves the overall antioxidant status in humans. © 2011 Elsevier Inc.. Source

Ogunmola O.J.,Cardiac Center | Akintomide A.O.,Obafemi Awolowo University | Olamoyegun A.M.,Diabetes and Metabolism Unit
BMC Research Notes | Year: 2013

Background: The Tei index is a Doppler-derived myocardial performance index. It is a measure of the combined systolic and diastolic myocardial performance of both the left and right ventricles. The incidence of heart failure (HF) is increasing globally, and its severity can be clinically assessed using the New York Heart Association (NYHA) functional classification and more objectively using echocardiographic assessment of systolic and diastolic functions. Thus, a measure of the combined systolic and diastolic myocardial performance could be a useful predictor of the severity of the clinical status of patients with HF. Results: Seventy-five newly presenting patients with HF of NYHA class II to IV and 60 normal controls were consecutively recruited. Using conventional two-dimensional and Doppler echocardiography techniques, the left ventricular parameters assessed were the isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), ejection time (ET), ejection fraction (EF), and end-diastolic volume (EDV). The Tei index was determined using the formula IVCT + IVRT/ET. The mean Tei index of patients was significantly higher than that of controls (0.884 ± 0.321 vs. 0.842 ± 0.14; p < 0.001). The Tei index ranged from 0.33 to 1.94 in patients and from 0.56 to 1.24 in controls. The mean EF was lower in patients than in controls (50.47% ± 19.01% vs. 68.35% ± 7.75%; p = 0.001). The mean EDV was higher in patients than in controls (171.39 ± 100.96 vs. 94.15 ± 28.54; p < 0.001). Comparison of the mean Tei indices of patients with HF of NYHA classes II, III, and IV showed statistically significant differences among all three groups (p < 0.001). Conclusions: The Tei index seems to be a clinically relevant indicator of cardiac function. It is reflective of the severity of HF as clinically assessed using the NYHA functional classification in patients with HF. © 2013 Ogunmola et al.; licensee BioMed Central Ltd. Source

Johar S.,Cardiac Center | Luqman N.,University of Brunei Darussalam
PACE - Pacing and Clinical Electrophysiology | Year: 2015

Background Appropriate left ventricle (LV) lead placement is integral to successful cardiac resynchronization therapy (CRT). Lead dislodgement and phrenic nerve stimulation (PNS) are major obstacles. A recent trial of an active fixation LV lead (Attain Stability 20066, Medtronic Inc., Tilburg, the Netherlands) has shown promising results. We share our initial experience with this novel active fixation LV lead. Methods A Medtronic active fixation lead 20066 was used in eight consecutive patients for CRT. An optimal site was chosen and recommended maneuvers were applied for lead fixation. Push and pull maneuvers were used to test stability. Results There were two initial dislodgements after which we used a transvalvular insertion (TVI) tool that was used in the hemostatic valve during rotation of the lead so that the torque was easily transmitted to the tip. It also allowed better tactile feedback during push-pull tests. There were no further dislodgements in the subsequent six patients. However, in one patient the lead could not be unscrewed due to the tip getting wedged at a distal smaller vein. Repositioning of the LV lead was done in three patients due to PNS or pacing issues. The median time for LV lead placement was 16.5 minutes (interquartile range 9-25 minutes). Conclusion The Medtronic Attain Stability 20066 active fixation LV lead can potentially be implanted at any pacing site avoiding PNS and providing better stability. The learning curve is short and additional tricks can be learnt to improve success. Use of TVI while the lead is rotated is beneficial. © 2014 Wiley Periodicals, Inc. Source

Kashour T.,Cardiac Center | Al-Tannir M.,Research and Publication Center | Bahamid R.,Prince Salman Heart Center
International Heart Journal | Year: 2014

Recent studies have suggested that omeprazole may reduce the inhibitory effect of clopidogrel on platelet aggregation. The United States Food and Drug Administration (FDA) has issued an update regarding this drug-drug interaction. This study aimed to evaluate the changing prescription pattern of omeprazole in patients taking clopidogrel after the FDA update regarding the clopidogrel-omeprazole interaction. A pharmacy database system was used to identify all prescriptions of clopidogrel alone, clopidogrel and omeprazole, or clopidogrel and ranitidine from May 1, 2009 until May 31, 2010. A total of 2,899 prescriptions were entered into the fi nal data analysis. There was a statistically signifi cant drop in omeprazole prescription with clopidogrel from 46.6% in the period before the FDA update to 38.2% after the update (P = 0.0037). In addition, a signifi cant increase was observed in the ranitidine prescription from 9.7% to 20.1% during the same time frame (P = 0.0059) without any signifi cant change between the two study periods for those on clopidogrel alone without any protective gastrointestinal bleeding drug (43% versus 41.7%). On the other hand, of the 732 patients who were on clopidogrel and omeprazole during the period before the FDA update, 396 patients (54.1%) were taken off omeprazole, 274 (37.4%) were kept on both drugs, 59 (8.1%) had their omeprazole switched to ranitidine after the FDA update, and 3 patients were lost to follow-up (0.4%). The present fi ndings indicate a signifi cant change in prescription pattern for omeprazole after the FDA update by taking patients off omeprazole or to a lesser extent replacing it with ranitidine. Source

Bennett S.R.,Cardiac Center
Surgery (United Kingdom) | Year: 2015

Sepsis remains a major cause of mortality in intensive care. The past 15 years has seen a more uniform, world-wide approach to the management of sepsis, severe sepsis and septic shock with improved survival. Recognizing the early symptoms and signs of sepsis are key: the confused, hypoxic, hypotensive patient with pyrexia, tachycardia, tachypnoea and leucocytosis. Examination must include search for a source of infection and early drainage or debridement. Next to take appropriate cultures, give fluids and broad-spectrum antibiotics. If the picture does not improve over the next 6 hours step-up the treatment to include urine output monitoring, blood gases for base excess, lactate, haemoglobin and glucose. These will guide the management of vasopressors, insulin, fluids, transfusion and bicarbonate. If the hypotension persists (septic shock) the patient should be moved to intensive care. The most recent recommendations include the withdrawal of starch based colloids, dobutamine in place of dopamine and a higher threshold for the use of steroids. This should be instituted within 24 hours of the start of sepsis. Advanced care includes mechanical ventilation using the ARDSnet protocol. Prevention by screening, stopping cross infection and appropriate use of antibiotics remains the first priority. Crown Copyright © 2015 Published by Elsevier Ltd. Source

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