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Introduction: The optimum treatment for acute viral myocarditis in pediatric population is unknown. Some studies have shown the beneficial effect of high dose intravenous immunoglobulin (IVIG) while other reports suggested the corticosteroid to be effective in the treatment of acute viral myocarditis. In this study, we present our experience with combined use of high dose IVIG and corticosteroid along with conventional antifailure treatment for clinical acute viral mypcarditis in pediatric population. Method and Results: Thirteen patients were included in the study with the clinical diagnosis of acute viral myocardistis and reduced cardiac function ie fractional shortening of < 28%. In the study group, 53% were male and 46% female with median age of 12 months and were treated with high dose IVIG and corticosteroid. Left ventricular function, left ventricular end diastolic dimension (LVEDD) and degree of mitral regurgitation (MR) were assessed echocardiographically at presentation; at 6 weeks and then at 6 months follow-up. At 6 months follow-up, LV function normalized in 92% of the patients, LVEDD improved in 62% and 84.6% of the patients had insignificant MR. Conclusion: Our data suggest that use of high dose IVIG in combination with corticosteroid is an effective treatment for acute viral myocarditis in pediatric population.

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Background: The objective was to explore the relationship between left ventricular ejection fraction (LVEF) assessed during hospitalization for acute myocardial infarction (MI) and later health-related quality of life (HRQoL). Methods: We used multivariable linear regression to assess the relationship between LVEF and HRQoL in 256 MI patients who responded to the Kansas City Cardiomyopathy Questionnaire (KCCQ), the EQ-5D Index, and the EuroQol Visual Analogue Scale (EQ-VAS) 2.5 years after the index MI. Results: 167 patients had normal LVEF (>50%), 56 intermediate (40%-50%), and 33 reduced (<40%). The mean (SD) KCCQ clinical summary scores were 85 (18), 75 (22), and 68 (21) (p < 0.001) in the three groups, respectively. The corresponding EQ-5D Index scores were 0.83 (0.18), 0.72 (0.27), and 0.76 (0.14) (p = 0.005) and EQ-VAS scores were 72 (18), 65 (21), and 57 (20) (p = 0.001). In multivariable linear regression analysis age ≥ 70 years, known chronic obstructive pulmonary disease (COPD), subsequent MI, intermediate LVEF, and reduced LVEF were independent determinants for reduced KCCQ clinical summary score. Female sex, medication for angina pectoris at discharge, and intermediate LVEF were independent determinants for reduced EQ-5D Index score. Age ≥ 70 years, COPD, and reduced LVEF were associated with reduced EQ-VAS score. Conclusion: LVEF measured during hospitalization for MI was a determinant for HRQoL 2.5 years later.

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The importance of the results of some large, randomized controlled trials (RCTs) on Hormone Replacement Therapy (HRT) has modified the risk/benefit perception of HRT. Recent literature review supports a different management. The differences in age at initiation and the duration of HRT are key points. HRT appears to decrease coronary disease in younger women, near menopause; yet, in older women, HRT increases risk of a coronary event. Although HRT is a recognized method in the prevention and treatment of osteoporosis, it is not licensed for the prevention of osteoporosis as a first-line treatment. The effectiveness of low and ultra-low estrogen doses has been demonstrated for the treatment of vasomotor symptoms, genital atrophy and the prevention of bone loss, with fewer side-effects than the standard dose therapy. Further research however, is needed to determine the effect both on fractures, as well as on cardiovascular and breast diseases. Newer progestins show effects that are remarkably different from those of other assays. The effectiveness of testosterone at improving both sexual desire and response in surgically and naturally postmenopausal women is shown by the testosterone patch. The intention, dose and regimen of HRT need to be individualized based on the principle of choosing the lowest appropriate dose in relation to the severity of symptoms and the time and menopause age.

[ABSTRACT]  [FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]