Background: The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was studied. Methods: Fifty-four CHF patients were randomized to (1) open-label RAN (RANCHF) added to usual therapy vs. (2) usual therapy (NORANCHF). Parasympathetic and sympathetic (P&S) measurements were taken at baseline and at 12 months. Results: A total of 16/27 (59%) patients in both groups had initially abnormal P&S measures, including high sympathovagal balance (SB), cardiovascular autonomic neuropathy (CAN) or both. High SB normalized in 10/12 (83%) RANCHF patients vs. 2/11 (18%) NORANCHF patients. SB became high in 5/11 (45%) NORANCHF vs. 1/11 (9%) RANCHF patients. CAN improved in 4/6 (67%) RANCHF patients vs. 5/7 (45%) NORANCHF patients. CAN developed in 1/11 (9%) RANCHF vs. 4/11 (36%) NORANCHF patients. Since improved P&S in RANCHF patients seemed independent of improved brain natriuretic peptide and impedance cardiography (BioZ) measurements, 5 day RAN was given to 30 subjects without CHF but with high SB or CAN. P&S improved in 90% of these subjects. Conclusions: RAN improves unfavorable P&S activity in CHF possibly by a direct effect upon autonomic sodium channels.

Introduction and objectives: Coronary heart disease is one of the complications of hypertension. Ambulatory blood pressure monitoring allows studying the different circadian patterns of blood pressure, but there is not enough evidence linking coronary heart disease with different circadian patterns. This research was carried out with the purpose of characterizing the circadian patterns of blood pressure in patients with essential hypertension and coronary heart disease. Methods: Descriptive and transversal research in 68 hypertensive patients with coronary heart disease who underwent ambulatory blood pressure monitoring. The different circadian patterns of blood pressure were related to the different forms of coronary heart disease and to the control of blood pressure. Results: In the sample, women (60.3%) predominated over men (39.7%). The ages were between 45 to 59 (63.3%) and those 60 and over (36.7%). 44.1% did not have their blood pressure under control, 45.6% were overweight and 38.2% were obese. The abnormal patterns were dipper 42.6%, non-dipper 41.2%, extreme dipper 7.4% and riser 8.8%. Morning surge was observed in 29 patients (42.6%), statistically significant in relation to the control of blood pressure (p = 0.033), but not with the different types of coronary heart disease studied. Conclusions: A statistically significant relationship was found between morning surge and control of blood pressure.

Aim: The aim of our study is to be able to predict the prognosis of patients with isolated pulmonary valvular stenosis on the basis of age and degree of stenosis. Identification of the course of pulmonary stenosis of different age groups will significantly contribute both to the physicians and the relatives of the patient. Material and Methods: 105 pediatric patients diagnosed with isolated pulmonary valvular stenosis were included in our study. We investigated the impact of the gradient of stenosis and the age at the time of diagnosis on the natural course of pulmonary stenosis. Mean follow-up time of the children was 19 months, 25.45±22.48 months. The patients were divided into four groups over their trans-valvular gradient degrees and<20 mmHg was defined as transient, 20-39 mmHg mild, 40-59 mmHg moderate, 60 mmHg and over as severe pulmonary stenosis. Results: Between two to five months, none of the moderate stenosis cases progressed unlike other patient groups. The decline in the final gradient versus initial gradient was significant in children between two to five months and six months to two years in our study, and yet there was no significant change of initial and final gradients in patients under one month, and at two years and over. Conclusion: It would be reasonable to conclude that the progression of pulmonary valvular stenosis is benign in patients with pulmonary valvular stenosis under 40 mmHg of systolic gradient diagnosed after 6th month of life.

Various heart diseases such as genetically-determined heart failure, acute myocardial infarction, ischemia-reperfusion injury and catecholamine-induced cardiomyopathies are associated with cardiac dysfunction, cellular damage, subcellular derangements and metabolic alterations. Since increase in myocardial Ca2+ is accompanied by these abnormalities, it is generally held that intracellular Ca2+-overload plays an important role in the pathogenesis of cardiac dysfunction as well as cellular and metabolic defects in different cardiovascular diseases. This view is supported by observations in hearts subjected to Ca2+-paradox, where reperfusion of Ca2+-free perfused hearts with Ca2+-containing medium was found to produce a marked increase in myocardial Ca2+-content, cellular damage and cardiac contracture. The intracellular Ca2+-overload in the heart has also been shown to produce mitochondrial Ca2+-overload, depress ATP production, release different toxic substances and induce cardiomyocyte apoptosis. By virtue of its ability to depress cardiac gene expression and increase proteolysis of sarcolemma (SL) sarcoplasmic reticulum (SR) and myofibrils (MF), the intracellular Ca2+-overload has been reported to reduce SL, SR and MF protein content and activities. Such remodeling of subcellular organelles is associated with dramatic alterations in Ca2+ -handling by SL and SR membranes as well as interaction of Ca2+ with MF for the impairment of cardiac function. Thus, it is evident that mitochondrial Ca2+-overload, and subcellular remodeling for Ca2+-handling defects are responsible for the occurrence of cardiac dysfunction, metabolic derangements and cellular damage during the development of heart disease.

Acinetobacter is an important nosocomial pathogen to cause infections such as pneumonia, bloodstream infections, meningitis, wound and surgical site infections including flesh eating bacterium necrotizing fasciitis and urinary tract Infections. A. baumannii can be spread through direct contact with surfaces, objects and the skin of contaminated persons. Acinetobactter has acquired resistance to most of the antibiotics and can play havoc in hospital environment due to its ability to survive desiccation and in moist environment in the presence of disinfectants. Currently, there are 32 genospecies of Acinetobacter known. Among these, A. baumannii is the most important in the clinical context, since it is the most frequently isolated in nosocomial infections and the one associated with the highest mortality rate. Objective To find out the frequency of A. baumannii causing surgical site infections after cardiac surgery and best antibiotic options for its treatment in patients admitted in Rawalpindi Institute of Cardiology. Materials and Methods A retrospective study was carried out to find out bacterial cultures in admitted patients at Rawalpindi Institute of Cardiology with surgical site infections from July 2017 to August 2018. A total of 405 pus specimens collected from patients with suspected surgical site infections were tested for bacterial culture and antimicrobial susceptibility test. Patient profile was noted from centralized hospital data. Results Out of total 405 specimens 13 were culture positive for A. baumannii (3.2%). Ten isolates were Pan Drug Resistant (PDR). Conclusion A. baumannii infection although infrequent in our set up is mostly pan resistant. Infection control practices & surveillance are important to avoid its spread in hospitalized patients.